Lumbar and Thoracic MET/ART Flashcards
Rules for thoracic and lumbar treatment
1) screen for TART to find area with most significant SD
2) perform diagnostic procedures on that vertebra plus one above and below
3) when treating with muscle energy, place monitoring thumb and first finger on TP of segment being treated with middle finger on TP of segment below
4) patient force is enough to engage the muscles under the monitoring hand
5) always finish muscle energy by taking to the final barrier before returning to neutral
6) REASSES
Upper Thoracic Spine: T1-T6
Test rotation and sidebending in neutral, flexion and extension
Flexed SD: posterior TP will become more posterior with extension and more symmetrical with flexion
Extended SD: posterior TP will either become more posterior with flexion and more symmetrical with extension
Neutral: posterior TP will stay the same
Seated Articulatory T1-T6 (Type 2 SD)
1) Physician behind or sits next to patient
2) place thumb on lateral aspect of TP of level with SD
3) use other hand to engage restrictive barrier of SD in all planes (usually flexion/extension motion engaged first to localize Type 2 dysfunction to the specific segment, followed by rotation and sidebending)
4) apply an articulatory activating force localized to the segment until no restricted motion
5) Reevaluate the segment for TART
Dx: T2 E SlRl
Tx: T2 F SrRr
Hand placement for muscle energy
place monitoring thumb and first finger on the TP of the segment being treated, with the middle finger on the TP of segment below to allow for localization
ME Seated T1-T6 (Type 2 SD)
1) Monitor TP of affected vertebra with pads of thumb and index finger and middle finger monitoring one below
2) place other hand on patient’s head explaining that this is the neutral position
3) induce flexion/extension, but only localize the one vertebrae
4) once localized, induce sidebending to restrictive barrier
5) instruct patient to return to neutral position
6) resist the effort for 3-5 seconds and then have patient relax
7) wait 1-2 seconds then move to the next RB
8) repeat 3-5 times
Dx: T3 E RrSr
Tx: T3 F RlSl
ME Seated T1-T6 (Type 1 SD)
1) monitor middle vertebrae of segment using pads of thumb and index finger and middle finger monitoring segment below
2) place the other hand on the patient’s head and explain to the patient that this is the neutral position
3) induce sidebending to the left by positioning by positioning your thigh beneath the right arm (more sidebending may be induced by leaning the patient toward the leg)
4) Induce rotation to the RB by rotating the head
5) Instruct patient to return to neutral position
6) resist 1-2 seconds, move to next RB, repeat
Dx: T1-3 N RlSr
Tx: T2 N RrSl
T5-12 Patient Positioning
-place hand of PTP behind neck and grasp elbow with other hand
T5-T12 Type 1 SD Positioning
- physician stands opposite of SD rotation and loops arm underneath patient’s armpit and grasps patients PTP bicep/shoulder
- induce sidebending and rotation to restrictive barrier
T5-T12 Type 2 SD Positioning
- physician stands opposite of SD direction of rotation and loops arm above patients arm and grasps patients PTP bicep
- induce sidebending and rotation to restrictive barrier
ME Seated Lower Thoracic SD (Type 1)
1) instruct patient to sit on the treatment table with their ipsilateral hand to the PTP clasped behind their neck and holding their elbow with the other hand
2) step away from the PTP
3) physician monitors vertebrae in the middle of the group using pads of thumb and index finger and middle finger monitoring segment below
4) place other hand on the patient’s bicep, by passing it beneath their left arm first and position patient to the sidebending and rotation
5) instruct patient to resist force and/or return to neutral position
6) resist patient efforts for 3-5 seconds and tell them to relax
7) wait 1-2 seconds and then take them to their next RB
8) repeat 3-5 times
9) Reassess
Dx: T8-T10 N RrSl
Tx: T9 N RlSr
ART Seated Lower Thoracic SD (Type 1)
1) instruct patient to sit on the treatment table with their ipsilateral hand to the PTP clasped behind their neck and holding their elbow with the other hand
2) step away from the PTP
3) physician monitors vertebrae in the middle of the group using pads of thumb and index finger and middle finger monitoring segment below
4) place other hand on the patient’s bicep, by passing it beneath their left arm first and position patient to the sidebending and rotation
5) induce motion in ART fashion through the RB while stabilizing the segment below until motion improves
6) Reassess
Dx: T8-10 N RrSl
Tx: T9 N RlSr
ME Seated Lower Thoracic SD (Type 2)
1) instruct patient to sit on the treatment table with their ipsilateral hand to the PTP clasped behind their neck and holding their elbow with the other hand
2) step away from the PTP
3) physician monitors vertebrae in the middle of the group using pads of thumb and index finger and middle finger monitoring segment below
4) place hand on patient’s bicep of PTP by passing above both arms
5) position patient to the flexion/extension, sidebending RB and then rotation barrier
6) instruct patient to resist force
7) wait, repeat, reassess
Dx: T7 E RrSr
Tx: T7 F RlSl
ART Seated Lower Thoracic SD Extension (Type 2)
1) instruct patient to sit on table with arm folded across chest
2) physician stands behind/beside patient, placing arm over patients shoulder with hand on opposite shoulder
3) physician stabilizes one segment below SD by grasping SP with index finger and thumb
4) flex thorax into RB to the level of the stabilizing hand
5) induce motion in an ART fashion through RB while stabilizing segment below SD until motion improves
6) reassess
Dx: T9 E RrSr
Tx: monitor T10 flex thorax
ART Seated Lower Thoracic SD Flexion (Type 2)
1) instruct patient to sit on table with arm folded across chest
2) physician stands behind/beside patient, placing arm over patients shoulder with hand on opposite shoulder
3) physician stabilizes one segment below SD by grasping SP with index finger and thumb
4) extend thorax into RB by applying anterior translation force of stabilizing hand and bending upper thoracic back
5) induce motion in ART fashion through RB while stabilizing segment below SD until motion improves
6) Reassess
Dx: T9 F RrSl
Tx: Monitor T10 extend
Articulatory Thoracic Sidebending Prone
1) stand on side of diagnosed sidebending dysfunction
2) place hand closest to feet (caudal) on ipsilateral TP of the affected segment, fingers pointed toward patients head
3) place hand closest to head (cephaldad) contralaterally with the heel of the hand over the opposite TP of the affected segment, fingers pointing toward feet
4) exert sufficient pressure downward toward table to produce articular motion of the spine
5) exert longitudinal force simultaneously with both hands to carry the affected segment through RB and hold it for 1-2 seconds
6) repeat steps 4 and 5 in rhythmic fashion until range of motion restored in affected segment
7) reassess
ART Seated Lower Thoracic Sidebending SD
1) doc stands or sit behind the patient who is seated with arms folded across chest
2) doc places arm over patient’s shoulder with hand on opposite shoulder
3) place thenar eminence at TP of dysfunctional vertebra on the ipsilateral side to the doc
4) doc induces sidebending force by pressing downward with the axilla while simultaneously pressing medially with thenar eminence
5) hold 1-2 seconds, return to neutral
6) repeat until motion improved
7) Reassess
ART Seated Lower Thoracic Rotation SD
1) doc stands behind the beside patient who is seated with arms folded across chest
2) doc places arm over patient’s shoulder with hand on opposite shoulder
3) place thenar eminence at TP of dysfunctional vertebra on contralateral side to the doc
4) doc induces rotation force by pulling shoulder anteriorly while pressing anteriorly with thenar eminence
5) hold 1-2 seconds, then return to neutral
6) repeat until motion improved
7) reassess
MET/ART Lumbar Seated (Type 1)
1) instruct patient to sit on treatment table with ipsilateral hand to the PTP clasped behind their neck and holding that elbow with their other hand
2) Step away from the PTP
3) Physician place hand on opposite bicep (over one bicep)
4) physician monitors middle segment TPs using pads of thumb and index finger and middle finger to monitor segment below
5) engage barrier by rotating and sidebending patient until motion is felt under monitoring hand
6) instruct patient to resist force or “return to neutral”
7) resist their efforts for 3-5 seconds
8) wait 1-2 seconds and then move to next RB
9) repeat and reassess
Dx: L1-3 N RrSl
Tx: L2 N RlSr
MET/ART Lumbar Seated Treatment (Type 2)
1) instruct patient to sit on treatment table with ipsilateral hand to the PTP clasped behind their neck and holding that elbow with their other hand
2) Step away from the PTP
3) Physician place hand on opposite bicep (over two biceps)
4) physician monitors middle segment TPs using pads of thumb and index finger and middle finger to monitor segment below
5) engage barrier by rotating and sidebending patient until motion is felt under monitoring hand
6) instruct patient to resist force or “return to neutral”
7) resist their efforts for 3-5 seconds
8) wait 1-2 seconds and then move to next RB
9) repeat and reassess
Dx: L2 E RrSr
Tx: L2 F RlSl
Seated Lumbar ART Sidebending SD
1) operator stands behind and beside patient who is seated with arms folded across chest
2) operator places arm over patient’s shoulder and hand on opposite shoulder
3) operator places thenar eminence at the TP of the dysfunctional vertebra on the ipsilateral side of the operator
4) operator induces sidebending force while pressing downward with axilla while pressing laterally with thenar eminence
5) hold 1-2 seconds and return to neutral
6) repeat until motion improved
Seated Lumbar ART Rotation SD
1) operator stands behind and beside patient who is seated with arms folded across chest
2) operator places arm over patient’s shoulder and hand on opposite shoulder
3) operator places thenar eminence at the TP of the dysfunctional vertebra on the ipsilateral side of the operator
4) operator induces rotating force while pressing downward with axilla while pressing laterally with thenar eminence
5) hold 1-2 seconds and return to neutral
6) repeat until motion improved
Lumbar Long Lever/Sidebending ME Treatment (Type1)
1) Monitor at apex of curve with hand closest to patients head
2) flex hips and knees until motion felt
3) lift patient’s ankles, meeting SB barrier
4) Instruct patient to resist force (push feet down) while you resist their force 3-5 seconds
5) wait 1-2 seconds then move to next RB
6) Repeat, reassess
Dx: L3-5 N RlSr
Tx: L4 N RrSl
Mnemonic: NUDR (Neutral dysfunction; PTP Up; patient force Down; lateral Recumbent
Lumbar ART Sidebending, Lateral Recumbent Sidebending SD
1) stand at side of table, in front of and facing patient
2) flex patients knees and hips to 90
3) palpate SP of lumbar spine
4) place hand and forearm under the patient’s ankle and list them toward ceiling
5) hold 1-2 seconds, return to neutral
6) repeat, reassess
Lumbar Long Lever/Sidebending ME Technique Extended (Type 2)
1) patient lateral rucumbent with torso rotated to table
2) monitor dysfunction with one hand
3) flex patient’s hips and knees engaging RB
4) drop patient’s legs off table, engaging SB
5) instruct patient to raise ankles up against operators counter resistance 3-5 seconds
6) wait 1-2 seconds, new RB
7) reassess
Dx: L4 E RrSr
Tx: L4 F RlSl
Mnemonic: SUUE (PTP Up, patient force Up, Extended SD)
Lumbar Long Lever/Sidebending ME Technique Flexed (Type 2)
1) patient lateral recumbent, physician in front of patient, PTP down
2) monitor dysfunction with hand
3) grasp patient’s arm and pull anterior/superior, engaging rotation and sidebending barriers
4) switch monitoring hand
5) straighten bottom leg, engaging extension barrier
6) engage sidebending barrier by lifting top anke
7) instruct patient to push toward floor with ankle against resistance, resist 3-5 seconds
8) wait 1-2 seconds, new RB
9) repeat, reassess
Dx: L4 F RlSl
Tx: L4 E RrSr
Mnemonic: FDDR (Flexed dysfunction; PTP Down; patient force Down; lateral Recumbent)
Lumbar Long Restrictor/Rotation ME (Type 1)
1) patient lateral recumbent; PTP down; physician facing patient
2) monitor dysfunctional segment with one hand while flexing the knees and hips with the other
3) patient’s top leg is lowered off the edge of the table causing anterior rotation of the pelvis; stabilize with thigh to prevent over-rotation
4) switch monitoring hands
5) use cephalad hand to move patient’s shoulder posteriorly until caudal hand detects motion
6) Option 1: patient pushes top shoulder forward against physician’s resistance for 3-5 seconds
7) Option 2: patient pulls hip posteriorly and cephalad against physician’s resistance
Dx: L3-5 N RrSl
Tx: L4 N RlSl
Lumbar Long Restrictor/Rotation ME Treatment Extended (Type 2)
1) patient lateral recumbent; PTP down; physician facing patient
2) caudal hand or thigh flexes patient’s knee and hips while cephalad hand monitors segment; flex hip until dysfunctional segment motion no longer felt (1st finger and thumb)
3) place patient’s top foot behind bottom knee in popliteal fossa
4) switch monitoring hand
5) use cephalad hand to move patient’s top shoulder posteriorly until the caudal hand detects motion (engages rotation barrier)
6) Option 1: patient pushes top forward against doctors resistance; operator gently moves patients shoulder posteriorly
7) Option 2: patient pulls hip posteriorly and cephalad against doctors resistance; physician moves patients pelvis anteriorly, engaging new sidebending and rotation barriers
Dx: L4 E RrSr
Tx: L4 F RlSl
Lumbar Long Restrictor/Rotation ME Flexed (Type 2)
1) patient lateral recumbent, PTP down; physician facing patient
2) caudal hand flexes patient’s knees and hips while cephalad hand monitors the segment; flex hip until motion is felt at the inferior segment (at middle finger)
3) place patient’s top foot behind the bottom knee in popliteal fossa
4) switch monitoring hands; use cephalad hand to move patient’s top shoulder posteriorly until the caudal hand (first finger and thumb) detects motion; extend the torso to feel motion at finger and thumb
5) Option 1: patient pushes shoulder forward against doctors resistance for 3-5 seconds; operator gently moves the patient’s shoulder posteriorly, rotating T/L spine to new RB
6) Option 2: patient pulls hip posteriorly and cephalad against doctor’s resistance for 3-5 seconds; physician moves patient’s pelvis anteriorly, engaging new sidebending and rotation barriers
Dx: L4 F RrSr
Tx: L4 E RlSl
